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Long-Term Outcomes of Endoscopic Papillectomy for Ampullary Adenomas

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Abstract

Background and Aims

Endoscopic papillectomy is a safe and effective treatment for ampullary adenomas and has mostly replaced surgical local resection. Recent data have discussed the role of endoscopic removal of laterally spreading adenomas associated with ampullary adenomas. We evaluated our long-term results of endoscopic papillectomy for ampullary adenomas.

Methods

We retrospectively analyzed patients who underwent endoscopic papillectomy of biopsy-proven adenomas at our tertiary center between 1994 and 2017. Clinical success was defined as complete excision of an adenoma with no evidence of recurrence during follow-up, no evidence of cancer, and without the need for surgery.

Results

A total of 161 patients (73M/88F) with a mean age of 61 (range 19–93) were included. Mean adenoma size was 20 mm (range 5–70). In total, 114/161 patients continued endoscopic surveillance for a minimum of 6 months with a median follow-up of 30 months (range 6–283). Recurrent adenomas were diagnosed in 8 patients (7%) after a median of 36 months (range 12–138). Clinical success was 83%; 35 laterally spreading adenomas were treated, which were larger than adenomas confined to the papilla (mean size 38 mm vs 15 mm, P < 0.05) and required more piecemeal resections (77% vs 15%, P < 0.05). However, no difference was found in recurrence rates between the two groups (8% vs 4%, P = 0.26); 24/161 (15%) of patients had adverse events including bleeding (6%) and pancreatitis (7%).

Conclusions

Endoscopic papillectomy is a safe and effective treatment for ampullary adenomas, including laterally spreading ones. Long-term surveillance demonstrates low recurrence rates at expert centers.

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Authors and Affiliations

  1. Digestive Disease Institute, Virginia Mason Medical Center, 1100 9th Ave, Seattle, WA, 98101, USA

    Nadav Sahar, Rajesh Krishnamoorthi, Richard A. Kozarek, Michael Gluck, Michael Larsen, Andrew S. Ross & Shayan Irani

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  1. Nadav Sahar
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  2. Rajesh Krishnamoorthi
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  3. Richard A. Kozarek
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  4. Michael Gluck
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  5. Michael Larsen
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  6. Andrew S. Ross
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  7. Shayan Irani
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Correspondence to Nadav Sahar.

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Conflict of interest

Dr. Irani and Dr. Ross both serve as consultants to Boston Scientific. Dr. Kozarek received research support from Boston Scientific regarding biliary and pancreatic self-expanding metal stents. The remaining authors have no financial relationships relevant to this article.

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Sahar, N., Krishnamoorthi, R., Kozarek, R.A. et al. Long-Term Outcomes of Endoscopic Papillectomy for Ampullary Adenomas. Dig Dis Sci 65, 260–268 (2020). https://doi.org/10.1007/s10620-019-05812-2

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  • DOI: https://doi.org/10.1007/s10620-019-05812-2

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